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Without Obamacare Penalty, Think It’ll Be Nice To Drop Your Health Insurance? Better Think Twice

Yves here. This post is a reminder that for most people in the US, health insurance is an exercise in exploitation thanks to the catastrophically costs of hospitalizations and certain medications. For instance, a leukemia survivor I know takes a drug that cost $14,000 a month to keep the cancer from recurring.

By Emily Bazar, Senior Editor and Columnist for California Healthline, who writes the “Ask Emily” column, which addresses readers’ concerns about the Affordable Care Act and other health care topics. She regularly appears on KPCC, KQED, Capital Public Radio and other California radio stations. Emily previously worked at the CHCF Center for Health Reporting, USA Today and the Sacramento Bee. She graduated from Stanford University. Originally published at Kaiser Health News

Dana Farrell’s car insurance is due. So is her homeowner’s insurance — plus her property taxes.

It’s also time to re-up her health coverage. But that’s where Farrell, a 54-year-old former social worker, is drawing the line.

“I’ve been retired two years and my savings is gone. I’m at my wit’s end,” says the Murrieta, Calif., resident.

So Farrell plans — reluctantly — to drop her health coverage next year because the Affordable Care Act tax penalty for not having insurance is going away.

That penalty — which can reach thousands of dollars annually — was a key reason that Farrell, who considers herself healthy, kept her coverage.

Now, “why do it?” she wonders. “I don’t have any major health issues and I’ve got a lot of bills that just popped up. I can’t afford to pay it anymore.”

Farrell is among millions of people likely to dump their health insurance because of a provision in last year’s Republican tax bill that repeals the Obamacare tax penalty, starting in 2019, by zeroing out the fines.

The Congressional Budget Office estimated that the repeal of the penalty would move 4 million people to drop their health insurance next year — or not buy it in the first place — and 13 million in 2027.

Some people who hated Obamacare from the start will drop their coverage as a political statement. For people like Farrell, it’s simply an issue of affordability.

Since Farrell started buying her own insurance through the open market in 2016, her monthly premium has swelled by about $200, she says, and she bears the entire cost of her premium because she doesn’t qualify for federal ACA tax credits. Next year, she says, her premium would have jumped to about $600 a month.

Instead, she plans to pay cash for her doctor visits at about $80 a pop, and for any medications she might use — all the while praying that she doesn’t get into a car accident or have a medical emergency.

“It’s a situation that a lot of people find themselves in,” says Miranda Dietz, lead author of a new study that projects how ending the penalty will affect California.

People like Farrell whose incomes are too high to qualify for tax credits are especially vulnerable, says Dietz, a research and policy associate at the University of California-Berkeley Center for Labor Research and Education. They must pay the entire premium themselves.

Premiums, even for a bronze plan with a deductible of more than $6,000, are enormous in some cases, she says. “The state’s done a great job of implementing the ACA,” she says, “but there are still Californians who just find insurance out of reach.”

Up to 450,000 more Californians may be uninsured in 2020 as a result of the penalty ending, and up to 790,000 more by 2023, boosting the state’s uninsurance rate for residents under 65 to 12.9 percent, according to the study. The individual market would suffer the biggest losses.

Covered California, the state health insurance exchange, predicts that enrollment in the individual market — both on and off the exchange — could drop by 12 percent next year, says agency spokesman James Scullary.

Exchange officials also blame the end of the penalty for a 3.5 percent average increase in premiums, because the departure of some healthy people from the market will lead to a sicker and costlier insurance pool.

Health insurance can be difficult to afford, but going without it is a “bad gamble,” Scullary says. Keep in mind: More than 22,000 Covered California enrollees broke, dislocated or sprained arms or shoulders in 2017, and 50,000 enrollees were either diagnosed with — or treated for — cancer, he explains.

“We know that none of those people began the year thinking, ‘This is when I’m going to break my arm,’ or ‘This is the year I get cancer,’” he says.

If you’re considering dropping your plan and risking the devastating financial consequences of an unexpected medical expense, check first to see if you can lower your premium.

“A big mistake for people is to look at the notice they get for their current health insurance and see it’s going up a lot and then throw up their hands and decide they’re going to go without,” says Donna Rosato, a New York-based editor at Consumer Reports who covers health care cost issues.

“Before you do that, look at other options.”

The most important thing to do is seek free help from a certified insurance agent or enrollment “navigator.” You can find local options by clicking on the “Find Help” tab on Covered California’s website, http://www.CoveredCA.com.

Next, see if you can qualify for more financial aid. For instance, if your incomeis close to the threshold to qualify for tax credits through Covered California or another Obamacare insurance exchange — about $48,500 for an individual or $100,000 for a family of four this year — check with a financial professional about adjusting it, Rosato suggests. You might be able to contribute to an IRA, 401(k) or health savings account to lower the total, she says.

Beyond that, be flexible and willing to switch plans, she advises. Consider different coverage levels, both on and off health insurance exchanges. If you’re in a silver-level plan (the second-lowest tier), you might save money by purchasing a less expensive bronze-level plan that has higher out-of-pocket costs but would protect you in case of a medical emergency.

This year, Farrell got a clean bill of health from her doctor after a round of tests. She’s nervous about being without coverage next year, but feels she doesn’t have a choice.

“It’s going to be the first time in my life I’m not going to have insurance,” she says.

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68 comments

  1. jackiebass

    Farrell appears to have made some bad financial decisions. She retired at 54. Unless she was unable to work she shouldn’t have retired so young. She could get a part time job to help pat the bills. I also suspect she is trying to live at a life style that ws the same as when she was working. She just didn’t accumulate a big enough cushion to do this.Too many people that can’t pay their bills aren’t good at managing their money.They buy many things they could survive without. If you don’t have disposable income , don’t spend on unnecessary things. I’m a retired school teacher. I retired at 57 when my last child finished college. I could have retired at 55 but knew it wasn’t economically feasible. I started teaching for $4200. It took me 20 years before I made $20,000. When I retired at 57, 20 years ago, I was making $50,000. There were years when it was hard to get by. With good money managing and part time jobs we survived. Some fit was luck but a lot was due to making good financial decisions. Too may people today fail to adequately plan for their future. I was lucky compared to proper today. When I got out of HS you could go into a factory and get a good paying job. If you didn’t like the job you cold easily get another one. I guess what I’m saying is financially look before you leap and plan for your future. It appears Farrell didn’t and is now paying the price.

    Reply
    1. Yves Smith Post author

      If she lost her job when she was over 45, she’s unemployable, particularly for anyone who provides health insurance to their employees. Employers are very much prejudiced against older people even before you get to the fact that they also are unwilling to pay the higher premiums for their health insurance. Pretty much everyone I know over 50 who is “retired” didn’t choose to be retired. I know people in their 50s who’ve tried to get part time work. The only one i know who succeeded was a Harvard PhD in math who still had to settle for a badly paid adjunct teaching job with no benefits. And that was after getting a series of on-the-come of jobs at startups (as in “we’ll pay you when we get some revenues”) that didn’t work out. And this woman was very connected but had an interrupted work history due to getting primary custody of her kids after a divorce.

      Reply
      1. Eudora Welty

        I need to say that I know several people (up to age 70) who have been hired recently. The 70-year-old was hired as Human Resources Director for a large retirement center (I don’t know the duties or level of authority). The person didn’t have another job, but left retirement life. As the population ages, I would think that being middle-aged or older might not be a liability. My skin gets thin when I read that no one 50 or over is getting hired. I can see where it is true in many professions, though.

        Reply
          1. Anon

            Yes. She is likely on Medicare. Or, in the case of some state workers who don’t pay into Social Security, on a state funded medical plan.

            Living in the US without medical insurance is a recipe for bankruptcy. (Being in a hospital without it is very different than being there with it. The very first thing a hospital physician asked me after coming conscious post emergency: “Do you have insurance?”)

            Reply
        1. ambrit

          Maam;
          Such might be true of “professional” level jobs, where credentials and or arcane knowledge are factors. For anything ‘lower’ on the social ‘value’ hierarchy scale, ‘Dog eat Dog’ is the applicable term, especially where physical labour is involved.
          Roughly speaking, this “Insurance” farrago points out one of the defining characteristics of the ‘Neo-Liberal Dispensation.’ Instead of dealing with the lowered need for labour to make a modern economy work by redistributing the fruits of the economy more fairly to those frozen out of the “labour market,” the present arbiters of the economy have chosen to decrease the labour pool. More machinery and automation means fewer humans are needed to maintain output. So, get rid of the now redundant humans! Making it difficult, if not outright impossible, for the ‘lower orders’ to have health care has the appearance of a “class cleansing campaign.”
          This is “The Jackpot” in action.

          Reply
        2. ambrit

          Short version; if you worked in any non-credentialed job before, there are younger and ‘hungrier’ people out there ready to be exploited for less and less.
          Neo-Liberalism at Work.
          With health “insurance” like this, it’s ‘The Jackpot’ in action.

          Reply
          1. Jean

            So, why can’t she rent out part of her house or apartment, drop her car insurance, sell the car, stop paying property taxes, claim a hardship exemption, live in food pantry rice and beans and thus be able to keep shoveling what’s left of her money to those nice insurance companies? How are the poor companies supposed to make a living with irresponsible greedy money oriented people like her in our economy?

            Seriously, if you want to see age discrimination, look at who is getting on the Google buses in San Francisco. I doubt that there is anyone over 35.

            Reply
    2. a different chris

      I’m sorry, but @77 you clearly have no clue of how much the world has changed. “I also suspect”…”don’t spend on unnecessary things”…”It appears Farrell didn’t” — I also have a thought: “don’t speculate in absence of facts”. How about that?

      Reply
    3. Corky

      Is it decades of corporate propaganda or basic human instinct (or both?) that causes so many of us to blame the victims of a predatory society?

      Reply
    4. False Solace

      Sociopathy in action. And notice the hypocrisy. jackiebass recites a long list of his/her personal virtues and describes how carefully he/she planned. Clearly jackiebass is an exceptionally wise and lucky individual who had a pension, a stable home life, and the ability to work part time jobs consistently. This person then turns around and finds fault with Farrell for not being equally exceptional. Exceptional, by definition, cannot apply to the majority of the population.

      So not only does it require exceptional ability and luck to succeed in this economy, but if you fail to be exceptional you’re the one to blame. You get kicked to your knees by the economy and kicked in the face by people who think they know better and will nitpick every crappy thing that ever happened to you. Do people make mistakes? Yes. Making mistakes is human. Honestly I find the entire attitude disgusting, but that’s what we get when people are driven by desperation to have a dog-eat-dog mindset.

      Reply
      1. RMO

        Getting any new work after 45 is damn hard in my experience. This even applied to a friend of mine who is an extremely skilled EE with tons of experience. Since his division at a major company was fired en mass I’ve noticed it has taken him on average of three years to find another job each time he’s been laid off – the last layoff came after a PE firm bought out the company he was working for. Trying to start a new career by going back to school sure hasn’t worked for me and I’ve tried both trade and academic business education. Despite very high grades in both the training only resulted in much experience with the resume black hole. I’ve worked hard, I’ve studied hard, I’ve been quite frugal but the real reason I’m not living under a bridge now is accident of birth – my parent’s business grew well (though due to a combination of circumstances we had to sell it in the 2000’s) and they had their first house (in the Vancouver area) fully paid for before the big early 80’s interest rate hikes.

        Reply
  2. Amfortas the hippie

    Two additional things…in Texas:
    the Medicaid Gap…quickly reinforced by Rickf^^kingperry just as soon as the Scotus made Medicaid Expansion optional for the states.
    Last I looked….which I admit I haven’t in a while, Texas makes it difficult to get clear information…The cutoff, for a family of four, to qualify for Adult Medicaid(unless yer pregnant, or officially disabled) was $240 or so per month.
    If your family of 4 is making that amount, you’re living in a cardboard box, and have bigger worries than insurance.
    The lowest level to qualify for subsidies for ACA was around $32K per year…IIRC.
    In addition to this sorry state of affairs(“we must punish the poor!”)…Perry also ramrodded through a bill that made being a Navigator a very risky endeavor. Penalties for speech, and the threat of jail if you used the wrong words.
    As a result, outside of the big cities, you can’t find a navigator with a Geiger counter.
    The few folks who can help you navigate the morass of insurance are few and far between…and do not call themselves “navigator”,lol. The ones I know of all work for the big Spanish Corp that bought up all the clinics and nursing homes and home health agencies in my far flung region.
    So you’re essentially on your own when the “enrollment period” rolls around. I’m smart enough to have taught myself Latin and enough Greek to pick through Herodotus…but I find that I am out of my depth when it comes to health insurance.
    While I loathe the Democrats and their Vichy treachery….the Repubs have been a disaster in Texas for everyone but the rich.
    Our Oncologist(who should rightly wear a cape) let slip that she would prefer a more Canadian system…and quickly apologised for such a breach of etiquette.
    we assured her that we were of the same mind…I said I was a frelling Socialist when it came to healthcare.
    She said,”people don’t have to wait for a hip, there”…and I said, “I sure did!” 6 1/2 years, enduring a dead hip and pain and suffering, on top of not being able to work, and all the social stigma that comes with that…
    But neither of my state representatives have working emails, it seems…and their federal counterparts no longer answer the phone.
    For all their supposed piety, those creatures deserve a hell.
    Fie.

    Reply
    1. Anonymous

      I would have hoped Greg Abbott would be a little better. After all, he was without insurance when that tree fell on him and broke his back. Or so we were told when they had fundraisers at Vanderbilt for him. Or does he just figure that everyone should have enough social capital to get fundraisers at rich schools?

      Reply
      1. Harrold

        Abbott sued the insurance company of the house whose tree fell on him. IIRC, he recieved $3 million in compensation.

        Abbott then supported legislature restricting the rights of victims to sue insurance companies for personal injury cases like his.

        Reply
  3. David Carl Grimes

    If a lot of healthy people make this calculation, this could accelerate the death spiral of Obamacare because insurance companies will be stuck with a lot of unhealthy people.

    Reply
    1. JTMcPhee

      “UNsurance companies will be stuck with a lot of unhealthy people”? Maybe not, policies “renew” annually, and you can bet the ever-inventive “smart people” in the UNsurance companies’ Denial Departments, and their lawyers and lobbyists, are working (unpaid?) overtime to figure out how to evade any “unfortunate” coverage decisions and kick the infirm off the risk rolls…

      It’s a lot like what’s coming down the pike in the way of global biosphere disruption and collapse — short-term and dys-social behaviors are baked in and reinforced by the Few, for their “gain,” while the world burns.

      A good question from the other day — what is the “American” equivalent of the gilet jaune? Can’t see many items to choose from, and who knows how the Bernaysians and state security (sic) will warp the French expression of desperation and anger, but in the US, going by the past, the rage will turn into mopes killing mopes — with a little meme-bending, cattle-prodding, riot gas and agents provacaeur to channel the “riotous mob.”

      Reply
  4. Paul Harvey 0swald

    This bit: contribute to an IRA smacks of “let them eat cake”. The example set forth, Ms. Farrell, is already retired.
    Did the author read the article?

    Reply
    1. Yves Smith Post author

      Help me. This is general advice. If someone is close to an Obamcare cutoff, the point is a small IRA contribution could be more than offset by Obamacare subsidies. This is not nuts and you are incorrect to deride it as an idea.

      You can still contribute to an IRA up to the mandatory withdrawal age of 70 1/2, so past the age of Medicare eligibility.

      Reply
        1. Yves Smith Post author

          Help me.

          If she’s not working she would be eligible for Medicaid.

          And as I said, this was general advice for people who might hit an Obamacare income level where they were not eligible for subsidies. Not being eligible = having a highish income.

          Reply
            1. Amfortas the hippie

              Aye! see mine above.
              medicaid eligibility is ridiculous.
              and to get declared “officially disabled” is like mating elephants.
              my four times through the regular disability process, they sent me to their kept doctor.
              each time i hobbled through the door, he said, “well, you’re obviously disabled”….but his recommendation was ignored by the bean counters.
              at issue was whether or not there was a job I could conceivably do “in the national economy”…perhaps in the us virgin islands…
              didn’t matter one bit where I lived.
              and I was helpfully provided a short list of occupations to consider…”cutter and paster” and “order taker”.
              I looked them up…the former had been, as I intuited, phased out long ago by tech. The latter, I still don’t know,lol.
              regardless…nothing like that within 100 miles of me.
              the entire thing is about denying you repeatedly until you give up….as well as belittling you and assuming that you’re a criminal.
              in the end, after 6 years of this, I was informed that I didn’t have enough work credits to qualify…who knew that they whittled away?
              but then ssi caught me in it’s net…and I got my hip…and then Texas Medicaid took a turn for the worse, and nobody accepted new medicaid patients.
              my regular doctor said that if I were a new patient, rather than being with him for 18 years, he could not accept me.
              I’m better for the hip…but I hurt all over all the time…in no small part due to compensating for the hip and ankle for so long(“lift with yer knees” is all well and good,lol).
              I require the freedom to do nothing, some days…but lay there in agony.
              I am as far as can be from a reliable employee.
              so now, just as wife is part time, at best, due to cancer…I am cut off…because she got a raise less than a month before the cancer diagnosis…and the suspicion from ssi is that the default assumption was right…that I am perhaps a criminal fraudster,lol.
              so she’s got medicaid(thankfully!!), but I do not…and am reluctant to try again…that 6+ year struggle took a lot out of me…body, mind and soul…
              I fear clawbacks and all manner of things that lurk in the fog of Texas government.
              so I will do without healthcare…and apply myself in the garden this spring,and the shop this winter, and fret about how to make any money, at all.
              I can totally understand the burn it all down sentiment that seems to be growing in the interstices everywhere.
              the elite have broken the social contract and should rightly feel some consequences for that betrayal.

              Reply
              1. ambrit

                I hear you and understand.
                Many make light of the phenomena of “gunned up” in America, as if it were a strictly Right wing affair. It is equal opportunity.
                The inchoate rage I’m seeing bodes ill for the stability of the society.
                Trump may soon find himself in the situation of the man who rides the tyger; unable to dismount.
                Lest the Political nomenklatura thinks that it can jump out in front of the mob and call it a parade, they will receive an unpleasant shock when the ‘parade’ ends up in front of the guillotines in the town square.

                Reply
          1. Todde

            Yes.

            But nobody lives in generalities and in this womans actual case, the advice probably is incorrect.

            income levels determine who is eligible for Medicaid.

            And since her income makes her ineligible for the insurance credit, she probably isnt eligible for Medicaid.

            And if she was eligible to contribute to an IRA, it appears from the atory that she lacks the actual funds to do so.

            Lack of funds is a different problem than lack of tax planning.

            Reply
          2. pissed younger baby boomer

            My mom passed away this year ,when the estate taxes paid next year ,the house deed will transfer to me.I had insurance agent come to my house I am disabled receive SSDI check not enough to live on . He recommend Medicare Disadvantage is private insurance scam , then he suggested Oregon Medicaid like most of the 49 states ( except AZ max income $1000 month unlimited physical assets cars to land) back to the 49 states including . I would have to sell the house and contents I will transfer to me to be a Medicaid client ,forget section 8 housing Pres George W Bush destroyed 8 section funding since then has not been restored since George left W.H. I just set a home based small business online retail .Once any one on Medcaid you are at the bottom the rest of life.

            Reply
      1. ChiGal in Carolina

        It should be said also that you need earned income to get a subsidy, as I discovered when (not having taken one up front cuz of not knowing when and if I would be employed after relocating in 2016) filing my taxes and despite having paid $12,000 in premiums and having another $17,000 of medical expenses in 2017 (two total knee replacements so I hit my max out of pocket), I qualified for no subsidy because my income was entirely from renting out my condo in Chicago and dipping into inherited funds.

        Not complaining, I am fortunate to have resources. But I am not wealthy by any stretch and those premiums were a huge percentage of my monthly income. I was stunned to find I didn’t qualify for a subsidy.

        So anyone who cobbles together an income by renting out a room in their home etc. won’t get a subsidy.

        Reply
  5. cnchal

    Never asked is why is the price tens of thousands to set a broken arm in the US “””health care””” system..

    Reply
    1. Wukchumni

      It took me almost a month of waiting to get an MRI on my knee, after the insurance company rejected me from getting one done initially. I got x-rays pretty quick though, which costs almost nothing in comparison.

      Those are the sort of ‘horror stories’ the right likes to pepper Canadian universal healthcare with, but no need to go up over, we’ve got that malarkey right here, right now.

      Reply
    2. NotTimothyGeithner

      Insurers are willing to pay. Is it asked.

      Structurally, I assume its a by-product of pre-HMO Act of 1973 health care providers effectively being non-profit. As a result, insurers don’t seem to have sufficient capacity to monitor and go over pricing. Then of course, many of the top executives are running out the clock at that point. With the money CEO’s of hospitals are pulling down, why shake the boat? This is why we need higher taxes to prohibit this kind of behavior.

      This is why there is a focus on government negotiated prices, because the Federales actually have this knowledge, or the relative bang for your buck returns between the U.S. system and the other countries lacking a “uniquely American system.”

      Reply
      1. JTMcPhee

        I recently climbed out of the trenches (retired from nursing,) but I have to challenge that assertion that “insurers are willing to pay.” I spent about a quarter of my working hours as a back-office nurse on trying to force the UNsurance companies to honor their own written policies, both the ones they contract with the UNsureds and their written and published statements of coverage and formularies, and their “procedures,” (which are larded with ways to escape the duty to the policy holder).

        UNsurance companies exist to make as much profit as possible, even “illegally” by denying coverage to people who pay the outrageous premiums and live under the cloud of thousands of dollars of ‘deductibles’ and ‘donut holes.” Many of the “professionals” they hire to do “utilization reviews” and set up “peer-to-peer” situations where not all doctors can afford to take the time to fight for the rights of the UNsured against the profit-biased “no coverage for that” system, take their charge to be to drag out the process and exhaust the people seeking or actually providing “health care” (disease and injury diagnosis and treatment, which is a subset of “health care.”)

        I get VA medical coverage. It is spotty on some problems, but was getting better. A 90 day supply of formulary meds by mail costs about $9, because of federal funding but more important, because the VA system can “negotiate from strength” with the looters and Robber Barons of Pharma.

        I have to add that the neoliberals are pressing, every day, to turn more and more of the VA system over to privatization and outsourcing, in the name of “providing better service to our Wounded Warriors.” Not working out the way it is being sold, of course — as with all Neoliberal “programs.”

        So since the world is starting to burn, maybe no one, or not enough of us in any position to effectuate healthy processes, really cares much about anything but personal gain and hedonism, a la “On The Beach” meets “Soylent Green…”

        And it’s UNsurance because you as a mope are UNsure whether your doctor will be “in network” from week to week, UNsure whether your necessary medications will be “on formulary,” UNsure what your UNsurance costs will be either from year to year or as a result of that employment of non-network providers to peek in on your distress and bill you (Surprise!) at ‘non-contracted rates” for some part of your “treatment,” UNsure if the UNsurer will phony up some reason to deny coverage for “undisclosed pre-existing conditions” (they of course have access to all your Big Data when writing coverage, but don’t fail to declare that hangnail infection back in 1984 in your application,) UNsure, UNsure, UNsure.

        I wonder if a large enough mass of people (and “business interests,” many of whom ought to be squarely behind national MMT-funded health care) can be gathered, to overcome the distinct advantage of the looters and their lobbyists being “on campus” with their bribe money and log-rolling, there in the Imperial capital…

        Reply
  6. Congenital warts

    My wife resigned from her state job 18 months ago. Our Cobra coverage is expiring and we will be getting our insurance through the ACA marketplace from now on.
    We live in rural N.C. and our only option is N.C. BCBS. We earn too much to qualify for a subsidy.
    Our lowest cost option is a bronze level plan at $1980 per month with a $24,000 family deductible. $48,000 per year before insurance kicks in to any meaningful degree? It is absolutely absurd.
    I run a small business which I started myself 10 years ago. It’s a blue collar business with 10 or so employees. I make a good living but we are certainly not rich. Our standard of living is probably equivalent to unionized a Detroit autoworker back in the 70s. My wife is a stay at home mom (works for me part time) and we can afford to go on vacation. Our house is modest and our cars are a few years old.
    If single payer health care was put into effect and the state and federal income taxes I pay were increased 100% or essentially doubled, I would still come out ahead.
    I’ve been speaking with other small business owners in my area about what they do for health insurance. It turns out the majority of those that don’t qualify for a subsidy are old enough to enroll in Medicare. Those of us that have to pay full price and aren’t old enough for Medicare are stuck between a rock and a hard place. The system is unsustainable, something has to give.

    Reply
    1. NotTimothyGeithner

      “The system is unsustainable, something has to give.”

      https://www.cbsnews.com/news/its-official-double-digit-rate-hikes-for-obamacare/

      Not that the system was healthy before hand, but if we consider more traditonal reasons for HRC’s failed coronation, signs of the decay of the system are on display. The subsidies and being on your parents’ plan until you are 26 aspects delayed the crisis point. Perhaps, the system is decaying already as demonstrated by Trump. We had an almost two week national mourning period for a losing Presidential candidate. I doubt Sam Rayburn had that happen, and he was a net positive.

      AOC defeating Crowley sans a scandal. Its a district he could keep on lock down with minimal effort. Either the situation is getting out of hand or DC is getting too removed to function, the crisis is happening.

      Reply
    2. Louis Fyne

      Cut the defense budget by $500 billion. The US has no existential enemies. Keep 500 nukes in the back pocket.

      Stop being policeman to the world,dying for other country’s interests and sending the US Navy to literally 20 miles off of China and Russia.

      Not holding my breath. moar woar and protecting both the Saudis and Israelis is one of the few bipartisan points of agreement in the Beltway

      Reply
      1. TimH

        &Louis Fyne: policeman only where Israel is concerned, otherwise the soldiers (who aren’t the politician’s kids) are sent in to assist the regime change of countries who possess, or have influence over, oilfields. It’s war as a business strategy, sacrificing the poor at the expense of the rich… again.

        Reply
        1. JTMcPhee

          I’d argue that “policeman of the world” is a pretty apt comparison — given the behavior of a whole lot of cops and police departments protecting the property interests of owners/looters and keeping the rabble in order. And engaging in all kinds of corruption and mayhem and “internal rendition.” Like the Homan Square “black site” some of you may remember: https://www.theatlantic.com/national/archive/2015/02/behind-the-disappeared-of-chicagos-homan-square/385964/ These are not friendly Irish beat cops from the old movies…

          Troops in Notagainistan, protecting the poppy crops and propping up the corrupt “government” and running “kill for fun” squads. Or doing “something” in Niger, droning hither and yon. Guantanamo and Abu Ghraib. “Police” actions, all right.

          Reply
    3. TBT

      This plan would seem not ACA compliant, ACA compliant plans for 2018/2019 would need to have a maximum out of pocket no greater than $14,700/$15,800 for a family, (which would have to be equal or higher than deductible). Little difference I know but seems like they are skirting rules with that plan design.

      Reply
      1. ChiGal in Carolina

        I am in NC and on the ACA and the out of pocket maximums you cite are what I pay as an individual.

        The plan is probably ACA compliant alright, just not compliant with human decency.

        Reply
          1. ChiGal in Carolina

            I stand corrected, my max was around $7,000 in 2017 (my premiums were $1000/mo). That’s why I basically got the second knee replacement free if did it in the same calendar year, so I felt I had to.

            I guess it was uncovered costs that drove my medical expenses up to around $30k that year. I had some home care for each surgery which wasn’t provided and I get one of my prescriptions from overseas because even with insurance it is prohibitively expensive ($50 vs $600/mo). Still hard to see how all that stuff could have added up to $10k but it did.

            Reply
              1. TBT

                Copays should typicaly count towards OOP limit, however I don’t think there are rules on out-of-network limits , maybe a surprise bill from OON surgeon or balance billing?

                Reply
          2. jrs

            You are right, this is what I see in California, you know a state that’s actually trying to comply with the ACA. The deductibles are still ridiculous but as you state.

            Reply
            1. Congenital warts

              $15,800 family deductible in network, $31,600 deductible out of network. $35,350 max out of pocket. Family of 4, all healthy, 2 school age kids, 2 adults near 50. Plan has increased in price from $1980 to $2052 per month.

              Reply
              1. ChiGal in Carolina

                Yeah, you are pretty much confined to network. But the max out of pocket you cite is not correct for an ACA family plan. (That your $24k of premiums don’t count as part of that max is why we need M4A.)

                Silver lining dept is that preventive care and routine checkups are “free”, since you are all fortunately in good health.

                Reply
    4. ChiGal in Carolina

      Good on you for getting the word out.

      I have been active with a grassroots group in the triangle area, Health Care For All Y’all, that puts on events meant to reach across the divide to people who aren’t necessarily on the left. They would be interested in your story.

      http://www.healthcareforallyall.org

      Reply
    5. jrs

      yes, is it better in some abstract sense to have the average amount of health insurance than not? Sure, but when you get down to particulars, I don’t think anyone who hasn’t looked at them has any idea how BAD the bronze plans really are (although I’ve yet to see a 24k deductible, deductibles are very HIGH – 7.5k individual, 14k family etc. and about nothing but a stupid doctor visit is covered AT ALL until they are met – get in a car accident oh sorry neither the ambulance or the hospital visit is covered at all until that super high delectable is met, have a heart attack – the same, etc.). I was shocked that bronze plans literally do not cover emergencies (not until the deductible ..).

      These are bad plans period, catastrophic plans bought by precisely the people that CAN’T afford a catastrophe (or they wouldn’t be buying a @#$# bronze plan)

      Reply
    6. mtnwoman

      RIght there with you.
      In NC. Self employed. Make too much for the subsidy. Too young for Medicare.

      Cheapest plan is $1088/month. Deductible is $7900 before it pays a cent for anything more than a Pap.

      We live in a cruel country as this is ALL by design. It doesn’t have to be this way as most developed nations in the world have figured out solutions.

      Reply
  7. polecat

    I envision that if things go on as they are much longer, then yes, the camel’s vertebrae will disarticulate, as we are beginning to witness in France and elsewhere !

    Reply
    1. NotTimothyGeithner

      My biggest fear is the lack of civic infrastructure means the changes will revolve around mega churches. The 50 state strategy was important for creating a parallel structure which is being lost or was lost.

      Functions and organizations such as DSA’s taillight repair operation are of increasing importance not just for the help it provides but a reconstruction of a community.

      Reply
  8. LyonNightroad

    I feel obligated to point out that, in the absence of subsidies, going without health insurance is not a ‘bad gamble’. Averaged over a couple thousand lifetimes you would pay less without insurance than with insurance due to the expenses and profit of the insurer. This ignores your ability to pay of course… Which all just feels like an obvious argument for single payer…

    Reply
    1. rjs

      exactly. insurance companies are in business to make money. so as you point out, “averaged over a couple thousand lifetimes you would pay less (for your health care) without insurance than with insurance”

      Reply
  9. Larry

    While I agree that catastrophic events can be costly, the combination of rising premiums and deductibles makes insurance look like a lose-lose proposition.

    Case in point, I’m an officer on a non profit board that oversees our cooperative pre and after school program. Our director and two other full time staff have decent insurance. In a first, we extended insurance to the rest of the staff. It had been requested and we were in a good budget position to offer it. One of our board members works for Blue Cross here in Massachusetts and put forward several plans. When we finally settled on a plan and presented it to the employees, the board were slightly surprised that nobody took the plan.

    I wasn’t too surprised though as the out of pocket costs and deductibles didn’t look very favorable. Yet at the costs the program could bear, it was the best we could do.

    Reply
  10. Jean

    If your medical bills go to an outside collection agency,
    demand a detailed breakdown of the bill before you pay anything.

    If provided, they have just violated the privacy provisions of HIPAA,
    and you may have a lot more leverage with them.

    From The Debt Resistors’ Operations Manual
    available as a free, of course, download

    Reply
  11. DolleyMadison

    How is refusing to pay almost $50,000 (80% of my take home pay) for insurance and deductibles that pays 50% AFTER I reach the deductible a “bad gamble?” There are worse things than death and being extorted and impoverished “just in case” is one of them. I have been able to negotiate the cost of my care for the last 3 years. Haven’t died yet. The ONLY way to end this reign of terror is to WALK AWAY. You can in fact get great care outside the health care mafia’s regime. Going to Thailand soon to get my teeth fixed. State of the art care for 10% of what U.S. dentist would charge AFTER insurance.

    Reply
  12. Unna

    I don’t know how anyone puts up with this. I don’t think I’d be able to. Constant shopping each year, weighing costs, coverage, benefits, drugs covered, which Dr hospital specialist is OK. Life is too short. Here in BC, Canada my Personal Health Number is on the back of my drivers license. If you need health care you show them your Drivers license. That’s easy and end of story. One stop shopping for health insurance at the Drivers License office.

    I was, and perhaps still am, watching AOC closely. She’s young and is going to make mistakes and occasionally say foolish things. But she and a bunch of other progressives walked out of the pro corporate Dem orientation to demonstrate for, among other things, MfA. If Bernie is the Dem candidate, wins and has “coattails” MfA is gonna happen.

    Reply
  13. Not BCBS

    We dropped un-insurance a year ago and have been better off. We replaced it with paying cash and using Christian health sharing. Everyone is getting scammed by the health un-insurance industry. Even after a trip to the ER this year, we are better off paying cash than we are dropping tens of thousands per year on un-insurance. This is because the cash price of health care is much cheaper, and Christian health sharing is far more generous than un-insurance. Not having insurance has really worked out for us.

    Reply
  14. jake

    No brief here for the American health insurance industry or ACA, but what’s not explained is why Farrell is not eligible for subsidies (or Medicaid), if in fact she has low income or is near destitution.

    It doesn’t add up, as so many of these anecdotes fail to do.

    Reply
    1. ambrit

      I’d suggest that the monetary levels originally used to determine Medicaid eligibility were low even back then, and through devious accounting tricks, have not kept up with the rate of inflation in basic living expenses. At least here Down South, destitution means pretty much a dickensian quality poverty.
      A real world example. We two have roughly $1,500 USD a month in income. My wife gets Medicare. I do not. I do not qualify for Medicaid here in Mississippi. She gets a Medicaid benefit that pays her Medicare premium. That, as far as we have been able to find out, is all she qualifies for.
      If we did not own our house, we would be Royally Sc—-d. Rent alone would consume half of our monthly income.
      Always keep in mind that there are a lot of people worse off than you out “in the wild.”
      To that point I’ll add another example from our locale.
      I have been seeing a homeless man out and about for many months here. He usually hangs around the just out of town business strip to the west of Hatiesburg. I have given him the odd dollar or two over this time. Why? Because he is a paraplegic, living in an electric wheelchair. He never speaks, seeming to either be in a twilight state or just taciturn.
      Four days ago, around eight or nine PM, I saw him parked under the breezeway between a Winn Dixie store and a Michael’s store. He was bundled up and covered with a fitted sheet as a sort of personal tent. He was going to sleep there. He had his electric wheelchair plugged into an electric plug originally put in for some now removed vending machines.
      Two nights ago, I passed the same spot. The wheelchair was there, but the man was not. The sheet was on the ground and some items scattered on the ground around the wheelchair. Nothing about this in the local newspaper. The local police are mum. No one knows anything. How typical.
      Yet, in the local paper, homeless tent encampments are taken for granted. It is becoming part of the new norm.

      Reply
        1. jake

          This is how the article quotes her:

          ‘“I’ve been retired two years and my savings is gone. I’m at my wit’s end,” says the Murrieta, Calif., resident.’

          She lives in California, where Medicaid should be available. She’s retired, is much too young for SS and she says her savings are gone. What does she live on? If it’s less than $48,000/yr. she’s eligible for Obamacare subsidies, on an increasing scale as income declines, until the point where she qualifies for Medicaid.

          Granted, $48K a year will not protect anyone from destitution at the hands of the American health care system, with or without Obamacare, and is not sufficient income to carry unsubsidized health insurance. But the account offered is confused and vague to the point of deception.

          Reply

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